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Upcoming CPT® Changes
Pulmonary, critical care, and sleep physicians often provide services to patients, as well as consultative services to other health-care professionals, without a patient being present. This can be done via telephone or electronic (internet or electronic health record) communications. Many are not aware that Current Procedural Terminology (CPT®) codes were published to describe and define the work involved in these services. In 2019, there will be additional CPT codes available for health-care workers to use for these non-face-to-face services.
Telephone services are reported using CPT codes 99441-99443 and may be used for evaluation and management (E/M) services provided by telephone for an established patient that do not result in a patient visit within the next 24 hours or are associated with an E/M visit from the last 7 days.
99441 Telephone evaluation and management service by a physician or other qualified health-care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M serv ice provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion
99442 11-20 minutes of medical discussion
99443 21-30 minutes of medical discussion
These codes may not be reported by a provider more frequently than every 7 days. The details of the service should be documented in the medical record.
If the E/M service is prompted by an online patient request, then CPT code 99444 can be used.
99444 Online evaluation and management service provided by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient or guardian, not originating from a related E/M service provided within the previous 7 days, using the internet or similar electronic communications network.
This code may be reported only every 7 days and can not be related to a previous E/M evaluation in the last 7 days or to a previous surgical procedure. The service includes all of the communication (eg, related telephone calls, prescription provision, laboratory orders) pertaining to the online patient encounter.
There are also CPT codes for Interprofessional Telephone/Internet/Electronic Health Record Consultations. These codes are used when one health-care provider requests the opinion and/or treatment advice of another provider (consultant) for either a new or established patient without face-to-face contact between the patient and the consultant.
99446 Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional; 5-10 minutes of medical consultative discussion and review.
99447 11-20 minutes of medical consultative discussion and review
99448 21-30 minutes of medical consultative discussion and review
99449 31 minutes or more of medical consultative discussion and review
These codes are not used if the consultant has seen the patient in a face-to-face encounter within the last 14 days or the consultation results in a transfer of care or other face-to-face service with the consultant within the next 14 days. In addition, greater than 50% of the service time reported must be devoted to the medical consultative verbal or internet discussion. The request and reason for telephone/internet/electronic health record consultation by the requesting health-care professional should be documented in the patient’s medical record. After an oral report from the consultant is provided to the treating/requesting physician, a written report should be documented in the medical record. Consultations of less than 5 minutes should not be reported.
As noted, CPT codes 99446-49 require an oral and written report. A new code is added for 2019.
99451 Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a written report to the patient’s treating/requesting physician or other qualified health care professional, 5 minutes or more of medical consultative time.
CPT code 99451 describes a consultative service lasting more than 5 minutes and requires only a written report to the requesting physician. This was added recognizing that oral communications do not always occur between healthcare professionals and may facilitate consultative services in geographic areas with no specialists available.
99452 Interprofessional telephone/Internet/electronic health record referral service(s) provided by a treating/requesting physician or other qualified health care professional, 30 minutes.
CPT code 99452 is reported for 16-30 minutes preparing for the referral and/or communicating with a consultant. If more than 30 minutes is spent by the treating/requesting healthcare provider, then one would use a prolonged services code (99358-59).
As with all coding and billing issues, review the CPT manual for parentheticals that describe coding rules not included in the code description. In addition, not all CPT codes are paid by all providers. Knowledge of payer policies is, therefore, important for appropriate reimbursement.
Pulmonary, critical care, and sleep physicians often provide services to patients, as well as consultative services to other health-care professionals, without a patient being present. This can be done via telephone or electronic (internet or electronic health record) communications. Many are not aware that Current Procedural Terminology (CPT®) codes were published to describe and define the work involved in these services. In 2019, there will be additional CPT codes available for health-care workers to use for these non-face-to-face services.
Telephone services are reported using CPT codes 99441-99443 and may be used for evaluation and management (E/M) services provided by telephone for an established patient that do not result in a patient visit within the next 24 hours or are associated with an E/M visit from the last 7 days.
99441 Telephone evaluation and management service by a physician or other qualified health-care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M serv ice provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion
99442 11-20 minutes of medical discussion
99443 21-30 minutes of medical discussion
These codes may not be reported by a provider more frequently than every 7 days. The details of the service should be documented in the medical record.
If the E/M service is prompted by an online patient request, then CPT code 99444 can be used.
99444 Online evaluation and management service provided by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient or guardian, not originating from a related E/M service provided within the previous 7 days, using the internet or similar electronic communications network.
This code may be reported only every 7 days and can not be related to a previous E/M evaluation in the last 7 days or to a previous surgical procedure. The service includes all of the communication (eg, related telephone calls, prescription provision, laboratory orders) pertaining to the online patient encounter.
There are also CPT codes for Interprofessional Telephone/Internet/Electronic Health Record Consultations. These codes are used when one health-care provider requests the opinion and/or treatment advice of another provider (consultant) for either a new or established patient without face-to-face contact between the patient and the consultant.
99446 Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional; 5-10 minutes of medical consultative discussion and review.
99447 11-20 minutes of medical consultative discussion and review
99448 21-30 minutes of medical consultative discussion and review
99449 31 minutes or more of medical consultative discussion and review
These codes are not used if the consultant has seen the patient in a face-to-face encounter within the last 14 days or the consultation results in a transfer of care or other face-to-face service with the consultant within the next 14 days. In addition, greater than 50% of the service time reported must be devoted to the medical consultative verbal or internet discussion. The request and reason for telephone/internet/electronic health record consultation by the requesting health-care professional should be documented in the patient’s medical record. After an oral report from the consultant is provided to the treating/requesting physician, a written report should be documented in the medical record. Consultations of less than 5 minutes should not be reported.
As noted, CPT codes 99446-49 require an oral and written report. A new code is added for 2019.
99451 Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a written report to the patient’s treating/requesting physician or other qualified health care professional, 5 minutes or more of medical consultative time.
CPT code 99451 describes a consultative service lasting more than 5 minutes and requires only a written report to the requesting physician. This was added recognizing that oral communications do not always occur between healthcare professionals and may facilitate consultative services in geographic areas with no specialists available.
99452 Interprofessional telephone/Internet/electronic health record referral service(s) provided by a treating/requesting physician or other qualified health care professional, 30 minutes.
CPT code 99452 is reported for 16-30 minutes preparing for the referral and/or communicating with a consultant. If more than 30 minutes is spent by the treating/requesting healthcare provider, then one would use a prolonged services code (99358-59).
As with all coding and billing issues, review the CPT manual for parentheticals that describe coding rules not included in the code description. In addition, not all CPT codes are paid by all providers. Knowledge of payer policies is, therefore, important for appropriate reimbursement.
Pulmonary, critical care, and sleep physicians often provide services to patients, as well as consultative services to other health-care professionals, without a patient being present. This can be done via telephone or electronic (internet or electronic health record) communications. Many are not aware that Current Procedural Terminology (CPT®) codes were published to describe and define the work involved in these services. In 2019, there will be additional CPT codes available for health-care workers to use for these non-face-to-face services.
Telephone services are reported using CPT codes 99441-99443 and may be used for evaluation and management (E/M) services provided by telephone for an established patient that do not result in a patient visit within the next 24 hours or are associated with an E/M visit from the last 7 days.
99441 Telephone evaluation and management service by a physician or other qualified health-care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M serv ice provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion
99442 11-20 minutes of medical discussion
99443 21-30 minutes of medical discussion
These codes may not be reported by a provider more frequently than every 7 days. The details of the service should be documented in the medical record.
If the E/M service is prompted by an online patient request, then CPT code 99444 can be used.
99444 Online evaluation and management service provided by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient or guardian, not originating from a related E/M service provided within the previous 7 days, using the internet or similar electronic communications network.
This code may be reported only every 7 days and can not be related to a previous E/M evaluation in the last 7 days or to a previous surgical procedure. The service includes all of the communication (eg, related telephone calls, prescription provision, laboratory orders) pertaining to the online patient encounter.
There are also CPT codes for Interprofessional Telephone/Internet/Electronic Health Record Consultations. These codes are used when one health-care provider requests the opinion and/or treatment advice of another provider (consultant) for either a new or established patient without face-to-face contact between the patient and the consultant.
99446 Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional; 5-10 minutes of medical consultative discussion and review.
99447 11-20 minutes of medical consultative discussion and review
99448 21-30 minutes of medical consultative discussion and review
99449 31 minutes or more of medical consultative discussion and review
These codes are not used if the consultant has seen the patient in a face-to-face encounter within the last 14 days or the consultation results in a transfer of care or other face-to-face service with the consultant within the next 14 days. In addition, greater than 50% of the service time reported must be devoted to the medical consultative verbal or internet discussion. The request and reason for telephone/internet/electronic health record consultation by the requesting health-care professional should be documented in the patient’s medical record. After an oral report from the consultant is provided to the treating/requesting physician, a written report should be documented in the medical record. Consultations of less than 5 minutes should not be reported.
As noted, CPT codes 99446-49 require an oral and written report. A new code is added for 2019.
99451 Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a written report to the patient’s treating/requesting physician or other qualified health care professional, 5 minutes or more of medical consultative time.
CPT code 99451 describes a consultative service lasting more than 5 minutes and requires only a written report to the requesting physician. This was added recognizing that oral communications do not always occur between healthcare professionals and may facilitate consultative services in geographic areas with no specialists available.
99452 Interprofessional telephone/Internet/electronic health record referral service(s) provided by a treating/requesting physician or other qualified health care professional, 30 minutes.
CPT code 99452 is reported for 16-30 minutes preparing for the referral and/or communicating with a consultant. If more than 30 minutes is spent by the treating/requesting healthcare provider, then one would use a prolonged services code (99358-59).
As with all coding and billing issues, review the CPT manual for parentheticals that describe coding rules not included in the code description. In addition, not all CPT codes are paid by all providers. Knowledge of payer policies is, therefore, important for appropriate reimbursement.
Welcome Dr. Cowl!
As we greet our new CHEST President, Clayton T. Cowl, MD, MS, FCCP, we asked him for a few thoughts about his upcoming presidential year. He kindly offered these responses:
What would be one of the many things you would like to accomplish as President of CHEST?
We plan to increase the engagement of our membership, and, in do so, allow for more opportunities to serve in leadership roles, educate as faculty, or to participate in more of the wide array of educational opportunities within CHEST – whether the member is a long-tenured physician, a trainee, an earlier career researcher or educator, or a colleague in the care team, such as a respiratory therapist, advanced practice provider, or a pharmacist. CHEST has been and will continue to be a leader in delivery of education, and will further advance opportunities to present breaking research. Ultimately, the reason we are in medicine is to improve the care that we deliver to our patients, so it is incumbent upon us to keep the mission aimed toward “patient-centric” goals.
What do you consider to be the greatest strength of CHEST, and how will you build upon this during your Presidency?
Our greatest strength is our members, who bring a diversity of experience, expertise, and passion for what they do at the forefront. Together, with our incredibly talented and dedicated support staff at CHEST, as well as our industry and publishing partners, our organization is poised to bring medical education in pulmonary, critical care, and sleep medicine globally to the next level. The CHEST Foundation has stimulated important opportunities for research, increased the ability for younger members to attend meetings and actively engage in CHEST activities, and provided valuable information to patients in a language they can understand. Thanks to advances in technology, there are improved platforms for communicating with our membership and for delivering education in novel and more effective ways than ever before. We plan to double down on our strategic focus of utilizing innovation and new technologies to lead trends in education, influence health-care improvements for our patients and their families, and to deliver the latest in medical education to clinicians and investigators worldwide.
What are some challenges facing CHEST, and how will you address these challenges?
Many of our members are facing challenges in their practices – both domestically and internationally. Industry and employer-based sponsorship to attend meetings has declined, travel remains expensive, and time away from the practice has become more and more difficult for a variety of reasons. Our members are being challenged with greater regulatory and administrative burdens and are bombarded with the demands of work overload. In addition to working with other organizations to identify workplace burnout and, more importantly, to offer better solutions, we are focused on leveraging a variety of new technologies to bring our CHEST brand of quality education to all of our members, regardless of location, and to do so in a way that best suits individual needs. The traditional model of attending a large meeting comprised solely of didactic presentations is, frankly, becoming outdated. CHEST will continue to “tip the apple cart” of worn out educational delivery methods and look toward innovating courses that are more accessible, more effective and relevant, more affordable, and more fun.
And finally, what is your charge to the members and new Fellows of CHEST?
We have each been blessed with the opportunity to serve patients and their families in their times of need. Let’s not forget that privilege as we deliver care each and every day. The word “doctor” comes from an agentive noun of the Latin verb docēre (“to teach”). Regardless of where you practice, what your role is in the health-care paradigm, or whether your contribution is directly with patients or indirectly through research, education, or administration, we are all teachers in various ways to various people. That’s why the American College of Chest Physicians (CHEST) needs to listen to your needs, cultivate your collective wisdom, and continue to be the leading organization within our specialties for delivering medical education and, ultimately, for providing outstanding care and compassion to our patients.
As we greet our new CHEST President, Clayton T. Cowl, MD, MS, FCCP, we asked him for a few thoughts about his upcoming presidential year. He kindly offered these responses:
What would be one of the many things you would like to accomplish as President of CHEST?
We plan to increase the engagement of our membership, and, in do so, allow for more opportunities to serve in leadership roles, educate as faculty, or to participate in more of the wide array of educational opportunities within CHEST – whether the member is a long-tenured physician, a trainee, an earlier career researcher or educator, or a colleague in the care team, such as a respiratory therapist, advanced practice provider, or a pharmacist. CHEST has been and will continue to be a leader in delivery of education, and will further advance opportunities to present breaking research. Ultimately, the reason we are in medicine is to improve the care that we deliver to our patients, so it is incumbent upon us to keep the mission aimed toward “patient-centric” goals.
What do you consider to be the greatest strength of CHEST, and how will you build upon this during your Presidency?
Our greatest strength is our members, who bring a diversity of experience, expertise, and passion for what they do at the forefront. Together, with our incredibly talented and dedicated support staff at CHEST, as well as our industry and publishing partners, our organization is poised to bring medical education in pulmonary, critical care, and sleep medicine globally to the next level. The CHEST Foundation has stimulated important opportunities for research, increased the ability for younger members to attend meetings and actively engage in CHEST activities, and provided valuable information to patients in a language they can understand. Thanks to advances in technology, there are improved platforms for communicating with our membership and for delivering education in novel and more effective ways than ever before. We plan to double down on our strategic focus of utilizing innovation and new technologies to lead trends in education, influence health-care improvements for our patients and their families, and to deliver the latest in medical education to clinicians and investigators worldwide.
What are some challenges facing CHEST, and how will you address these challenges?
Many of our members are facing challenges in their practices – both domestically and internationally. Industry and employer-based sponsorship to attend meetings has declined, travel remains expensive, and time away from the practice has become more and more difficult for a variety of reasons. Our members are being challenged with greater regulatory and administrative burdens and are bombarded with the demands of work overload. In addition to working with other organizations to identify workplace burnout and, more importantly, to offer better solutions, we are focused on leveraging a variety of new technologies to bring our CHEST brand of quality education to all of our members, regardless of location, and to do so in a way that best suits individual needs. The traditional model of attending a large meeting comprised solely of didactic presentations is, frankly, becoming outdated. CHEST will continue to “tip the apple cart” of worn out educational delivery methods and look toward innovating courses that are more accessible, more effective and relevant, more affordable, and more fun.
And finally, what is your charge to the members and new Fellows of CHEST?
We have each been blessed with the opportunity to serve patients and their families in their times of need. Let’s not forget that privilege as we deliver care each and every day. The word “doctor” comes from an agentive noun of the Latin verb docēre (“to teach”). Regardless of where you practice, what your role is in the health-care paradigm, or whether your contribution is directly with patients or indirectly through research, education, or administration, we are all teachers in various ways to various people. That’s why the American College of Chest Physicians (CHEST) needs to listen to your needs, cultivate your collective wisdom, and continue to be the leading organization within our specialties for delivering medical education and, ultimately, for providing outstanding care and compassion to our patients.
As we greet our new CHEST President, Clayton T. Cowl, MD, MS, FCCP, we asked him for a few thoughts about his upcoming presidential year. He kindly offered these responses:
What would be one of the many things you would like to accomplish as President of CHEST?
We plan to increase the engagement of our membership, and, in do so, allow for more opportunities to serve in leadership roles, educate as faculty, or to participate in more of the wide array of educational opportunities within CHEST – whether the member is a long-tenured physician, a trainee, an earlier career researcher or educator, or a colleague in the care team, such as a respiratory therapist, advanced practice provider, or a pharmacist. CHEST has been and will continue to be a leader in delivery of education, and will further advance opportunities to present breaking research. Ultimately, the reason we are in medicine is to improve the care that we deliver to our patients, so it is incumbent upon us to keep the mission aimed toward “patient-centric” goals.
What do you consider to be the greatest strength of CHEST, and how will you build upon this during your Presidency?
Our greatest strength is our members, who bring a diversity of experience, expertise, and passion for what they do at the forefront. Together, with our incredibly talented and dedicated support staff at CHEST, as well as our industry and publishing partners, our organization is poised to bring medical education in pulmonary, critical care, and sleep medicine globally to the next level. The CHEST Foundation has stimulated important opportunities for research, increased the ability for younger members to attend meetings and actively engage in CHEST activities, and provided valuable information to patients in a language they can understand. Thanks to advances in technology, there are improved platforms for communicating with our membership and for delivering education in novel and more effective ways than ever before. We plan to double down on our strategic focus of utilizing innovation and new technologies to lead trends in education, influence health-care improvements for our patients and their families, and to deliver the latest in medical education to clinicians and investigators worldwide.
What are some challenges facing CHEST, and how will you address these challenges?
Many of our members are facing challenges in their practices – both domestically and internationally. Industry and employer-based sponsorship to attend meetings has declined, travel remains expensive, and time away from the practice has become more and more difficult for a variety of reasons. Our members are being challenged with greater regulatory and administrative burdens and are bombarded with the demands of work overload. In addition to working with other organizations to identify workplace burnout and, more importantly, to offer better solutions, we are focused on leveraging a variety of new technologies to bring our CHEST brand of quality education to all of our members, regardless of location, and to do so in a way that best suits individual needs. The traditional model of attending a large meeting comprised solely of didactic presentations is, frankly, becoming outdated. CHEST will continue to “tip the apple cart” of worn out educational delivery methods and look toward innovating courses that are more accessible, more effective and relevant, more affordable, and more fun.
And finally, what is your charge to the members and new Fellows of CHEST?
We have each been blessed with the opportunity to serve patients and their families in their times of need. Let’s not forget that privilege as we deliver care each and every day. The word “doctor” comes from an agentive noun of the Latin verb docēre (“to teach”). Regardless of where you practice, what your role is in the health-care paradigm, or whether your contribution is directly with patients or indirectly through research, education, or administration, we are all teachers in various ways to various people. That’s why the American College of Chest Physicians (CHEST) needs to listen to your needs, cultivate your collective wisdom, and continue to be the leading organization within our specialties for delivering medical education and, ultimately, for providing outstanding care and compassion to our patients.
CHEST Foundation – designated as a Combined Federal Campaign-approved charity
The CHEST Foundation was recently designated as a Combined Federal Campaign-approved charity! The federal campaign started on September 10 and runs through January 11, 2019. If you are a federal employee organizing your workplace giving, you can easily choose the CHEST Foundation as your designated charity! Simply list our CFC number when designating your selected charity! CFC Number: 24565
To set up your CFC account, follow these easy steps outlined below:
1. Visit https://cfcgiving.opm.gov/welcome
2. From the welcome page, select “sign up now,” and fill out the required information if you do not have an account. If you do have an account, simply log in using the email address tied to your CFC account and your password, and skip to step 6.
3. After your account is set up, the CFC will send you an email to the address you provided along with a verification pin number. Select the “CLICK HERE to enter your PIN” option from the verification email, and enter the provided pin on the page provided by the link.
4. On the next page, you will create your security questions to log back into your account, should you lose your password. Select “Save Changes” at the bottom of the page when you are ready to move on.
5. Next, you’ll be asked to fill out some personal information about yourself as a donor, such as your full name, and which department of the federal government you work for. Choose “Save Changes” at the bottom of the page when you are done.
6. Upon completing the profile page (or logging into your account), you will be directed to the welcome page. Select the “Pledge Now” button, located in the center of the page.
7. The next page will ask you questions about the charity you would like to support. Enter the CHEST Foundation’s CFC number: 24565, and click “Search for Charities” to be directed to the next page.
8. Select the “add” button next to the CHEST Foundation’s listing. Then click the “checkout” button that appears in the pop-up window.
9. Fill out the requested information regarding your pledge amount, your pledge frequency, and your annual pledge amount, then select the “Continue with your pledge” option at the bottom of the page.
10. On this final page, you can review your pledge amount and review a brief attestation agreement. After reviewing, check the “I confirm” checkbox, then click “submit pledge.”
That’s it!
Thank you for supporting the CHEST Foundation’s mission-based programming supporting patient education materials, clinical research grants, and community service initiatives.
The CHEST Foundation was recently designated as a Combined Federal Campaign-approved charity! The federal campaign started on September 10 and runs through January 11, 2019. If you are a federal employee organizing your workplace giving, you can easily choose the CHEST Foundation as your designated charity! Simply list our CFC number when designating your selected charity! CFC Number: 24565
To set up your CFC account, follow these easy steps outlined below:
1. Visit https://cfcgiving.opm.gov/welcome
2. From the welcome page, select “sign up now,” and fill out the required information if you do not have an account. If you do have an account, simply log in using the email address tied to your CFC account and your password, and skip to step 6.
3. After your account is set up, the CFC will send you an email to the address you provided along with a verification pin number. Select the “CLICK HERE to enter your PIN” option from the verification email, and enter the provided pin on the page provided by the link.
4. On the next page, you will create your security questions to log back into your account, should you lose your password. Select “Save Changes” at the bottom of the page when you are ready to move on.
5. Next, you’ll be asked to fill out some personal information about yourself as a donor, such as your full name, and which department of the federal government you work for. Choose “Save Changes” at the bottom of the page when you are done.
6. Upon completing the profile page (or logging into your account), you will be directed to the welcome page. Select the “Pledge Now” button, located in the center of the page.
7. The next page will ask you questions about the charity you would like to support. Enter the CHEST Foundation’s CFC number: 24565, and click “Search for Charities” to be directed to the next page.
8. Select the “add” button next to the CHEST Foundation’s listing. Then click the “checkout” button that appears in the pop-up window.
9. Fill out the requested information regarding your pledge amount, your pledge frequency, and your annual pledge amount, then select the “Continue with your pledge” option at the bottom of the page.
10. On this final page, you can review your pledge amount and review a brief attestation agreement. After reviewing, check the “I confirm” checkbox, then click “submit pledge.”
That’s it!
Thank you for supporting the CHEST Foundation’s mission-based programming supporting patient education materials, clinical research grants, and community service initiatives.
The CHEST Foundation was recently designated as a Combined Federal Campaign-approved charity! The federal campaign started on September 10 and runs through January 11, 2019. If you are a federal employee organizing your workplace giving, you can easily choose the CHEST Foundation as your designated charity! Simply list our CFC number when designating your selected charity! CFC Number: 24565
To set up your CFC account, follow these easy steps outlined below:
1. Visit https://cfcgiving.opm.gov/welcome
2. From the welcome page, select “sign up now,” and fill out the required information if you do not have an account. If you do have an account, simply log in using the email address tied to your CFC account and your password, and skip to step 6.
3. After your account is set up, the CFC will send you an email to the address you provided along with a verification pin number. Select the “CLICK HERE to enter your PIN” option from the verification email, and enter the provided pin on the page provided by the link.
4. On the next page, you will create your security questions to log back into your account, should you lose your password. Select “Save Changes” at the bottom of the page when you are ready to move on.
5. Next, you’ll be asked to fill out some personal information about yourself as a donor, such as your full name, and which department of the federal government you work for. Choose “Save Changes” at the bottom of the page when you are done.
6. Upon completing the profile page (or logging into your account), you will be directed to the welcome page. Select the “Pledge Now” button, located in the center of the page.
7. The next page will ask you questions about the charity you would like to support. Enter the CHEST Foundation’s CFC number: 24565, and click “Search for Charities” to be directed to the next page.
8. Select the “add” button next to the CHEST Foundation’s listing. Then click the “checkout” button that appears in the pop-up window.
9. Fill out the requested information regarding your pledge amount, your pledge frequency, and your annual pledge amount, then select the “Continue with your pledge” option at the bottom of the page.
10. On this final page, you can review your pledge amount and review a brief attestation agreement. After reviewing, check the “I confirm” checkbox, then click “submit pledge.”
That’s it!
Thank you for supporting the CHEST Foundation’s mission-based programming supporting patient education materials, clinical research grants, and community service initiatives.
CHEST keynote to bridge the gap between generations
Scott Zimmer, a product of generation X, went through college with a passion for public speaking, as well as a deep interest in the generational divide. In 2013, he began working for a company called BridgeWorks and so began his career as one of three speakers at this firm of “generational junkies and trend spotters.”
Founded in 1998, Bridgeworks strives to bridge the generational gaps that are found in all workplaces through research, keynote speakers, workshops, blogs, training, trivia, and more. Bridgeworks is a team of 13 people coming from the baby boomer generation down to millennials on the cusp of being classified with generation Z (gen edgers, as Zimmer calls them). Each team member has their own interesting and diverse background with a passion for the topic of generations, and everyone engages this passion by conducting research with the BridgeWorks team.
There are generational clashes in every single industry, according to Zimmer. Just at BridgeWorks, he even notices when simply sending a text he perceives as “normal” to one of his millennial coworkers, that it is sometimes received as curt and leaves the recipient concerned that they have done something to offend him. This topic is not foreign to anyone— everyone has had a moment of saying “kids these days,” or “ugh, old people.” Because of this, Zimmer starts every session knowing that each person will leave with relevant insights and actionable takeaways.
Zimmer also loves to integrate nostalgia into his presentations, and working with generational theory at BridgeWorks allows him to do just that in a way that helps drive home points and makes ideas more relatable. “Some people like to say we are all just people and we grow out of certain things. But we develop specific traits and values at an impressionable age, and I love looking at what was happening in our lives during those formative years. What are these shared experiences that will form who we are?” This love of nostalgia set Zimmer up for a great opportunity to develop his own trivia gameshow at BridgeWorks. GenPOP! is an interactive trivia gameshow that pairs members of different generations up and quizzes them on all things pop culture from different decades, while also teaching audience members new things about the people they interact with every day.
“So much goes into who we are and who shows up to the workplace, what effects our behavior, and our motivation,” says Zimmer when asked where his passion for this topic stems. “It could be our gender, the region we grew up in, or birth order, and I personally like looking at it through the lens of these different generations.”
So, what will Zimmer bring to CHEST 2018? During his keynote presentation in San Antonio, Zimmer will examine the generational gaps that are existent in the medical community. “You don’t want your young medical professionals to feel like they are sitting at the ‘kids table’ or being talked down to when they have something to share because they do not have equal experience.”
Each generation and each member of a medical team communicates differently, and understanding those differences and feeling like an equal part of the team is very important. How information is conveyed to patients and medical team members of any age affects how they perceive given information and the level of comfort that is felt by each party. Finding ways to bridge the obvious gaps between the generations is a key component to making any team work efficiently.
Scott Zimmer, a product of generation X, went through college with a passion for public speaking, as well as a deep interest in the generational divide. In 2013, he began working for a company called BridgeWorks and so began his career as one of three speakers at this firm of “generational junkies and trend spotters.”
Founded in 1998, Bridgeworks strives to bridge the generational gaps that are found in all workplaces through research, keynote speakers, workshops, blogs, training, trivia, and more. Bridgeworks is a team of 13 people coming from the baby boomer generation down to millennials on the cusp of being classified with generation Z (gen edgers, as Zimmer calls them). Each team member has their own interesting and diverse background with a passion for the topic of generations, and everyone engages this passion by conducting research with the BridgeWorks team.
There are generational clashes in every single industry, according to Zimmer. Just at BridgeWorks, he even notices when simply sending a text he perceives as “normal” to one of his millennial coworkers, that it is sometimes received as curt and leaves the recipient concerned that they have done something to offend him. This topic is not foreign to anyone— everyone has had a moment of saying “kids these days,” or “ugh, old people.” Because of this, Zimmer starts every session knowing that each person will leave with relevant insights and actionable takeaways.
Zimmer also loves to integrate nostalgia into his presentations, and working with generational theory at BridgeWorks allows him to do just that in a way that helps drive home points and makes ideas more relatable. “Some people like to say we are all just people and we grow out of certain things. But we develop specific traits and values at an impressionable age, and I love looking at what was happening in our lives during those formative years. What are these shared experiences that will form who we are?” This love of nostalgia set Zimmer up for a great opportunity to develop his own trivia gameshow at BridgeWorks. GenPOP! is an interactive trivia gameshow that pairs members of different generations up and quizzes them on all things pop culture from different decades, while also teaching audience members new things about the people they interact with every day.
“So much goes into who we are and who shows up to the workplace, what effects our behavior, and our motivation,” says Zimmer when asked where his passion for this topic stems. “It could be our gender, the region we grew up in, or birth order, and I personally like looking at it through the lens of these different generations.”
So, what will Zimmer bring to CHEST 2018? During his keynote presentation in San Antonio, Zimmer will examine the generational gaps that are existent in the medical community. “You don’t want your young medical professionals to feel like they are sitting at the ‘kids table’ or being talked down to when they have something to share because they do not have equal experience.”
Each generation and each member of a medical team communicates differently, and understanding those differences and feeling like an equal part of the team is very important. How information is conveyed to patients and medical team members of any age affects how they perceive given information and the level of comfort that is felt by each party. Finding ways to bridge the obvious gaps between the generations is a key component to making any team work efficiently.
Scott Zimmer, a product of generation X, went through college with a passion for public speaking, as well as a deep interest in the generational divide. In 2013, he began working for a company called BridgeWorks and so began his career as one of three speakers at this firm of “generational junkies and trend spotters.”
Founded in 1998, Bridgeworks strives to bridge the generational gaps that are found in all workplaces through research, keynote speakers, workshops, blogs, training, trivia, and more. Bridgeworks is a team of 13 people coming from the baby boomer generation down to millennials on the cusp of being classified with generation Z (gen edgers, as Zimmer calls them). Each team member has their own interesting and diverse background with a passion for the topic of generations, and everyone engages this passion by conducting research with the BridgeWorks team.
There are generational clashes in every single industry, according to Zimmer. Just at BridgeWorks, he even notices when simply sending a text he perceives as “normal” to one of his millennial coworkers, that it is sometimes received as curt and leaves the recipient concerned that they have done something to offend him. This topic is not foreign to anyone— everyone has had a moment of saying “kids these days,” or “ugh, old people.” Because of this, Zimmer starts every session knowing that each person will leave with relevant insights and actionable takeaways.
Zimmer also loves to integrate nostalgia into his presentations, and working with generational theory at BridgeWorks allows him to do just that in a way that helps drive home points and makes ideas more relatable. “Some people like to say we are all just people and we grow out of certain things. But we develop specific traits and values at an impressionable age, and I love looking at what was happening in our lives during those formative years. What are these shared experiences that will form who we are?” This love of nostalgia set Zimmer up for a great opportunity to develop his own trivia gameshow at BridgeWorks. GenPOP! is an interactive trivia gameshow that pairs members of different generations up and quizzes them on all things pop culture from different decades, while also teaching audience members new things about the people they interact with every day.
“So much goes into who we are and who shows up to the workplace, what effects our behavior, and our motivation,” says Zimmer when asked where his passion for this topic stems. “It could be our gender, the region we grew up in, or birth order, and I personally like looking at it through the lens of these different generations.”
So, what will Zimmer bring to CHEST 2018? During his keynote presentation in San Antonio, Zimmer will examine the generational gaps that are existent in the medical community. “You don’t want your young medical professionals to feel like they are sitting at the ‘kids table’ or being talked down to when they have something to share because they do not have equal experience.”
Each generation and each member of a medical team communicates differently, and understanding those differences and feeling like an equal part of the team is very important. How information is conveyed to patients and medical team members of any age affects how they perceive given information and the level of comfort that is felt by each party. Finding ways to bridge the obvious gaps between the generations is a key component to making any team work efficiently.
Impact factor news for the journal CHEST®
The journal CHEST® was recently awarded a 2-year impact factor of 7.652, the highest in its history, which equates to a 24% increase over last year’s score. In addition, our 5-year impact factor is 7.854, a 7% increase over last year. With respect to the 2-year factor, CHEST® is ranked 4th out of 33 journals in the Critical Care category and 7th out of 59 journals in the Respiratory System category.
Our recent Eigenfactor places us as the second-highest ranked journal in both respiratory and critical care categories. The Eigenfactor metric adjusts the impact factor by eliminating self-citations and factoring in citations in the top-tier journals.
Congratulations to our journal CHEST® !
The journal CHEST® was recently awarded a 2-year impact factor of 7.652, the highest in its history, which equates to a 24% increase over last year’s score. In addition, our 5-year impact factor is 7.854, a 7% increase over last year. With respect to the 2-year factor, CHEST® is ranked 4th out of 33 journals in the Critical Care category and 7th out of 59 journals in the Respiratory System category.
Our recent Eigenfactor places us as the second-highest ranked journal in both respiratory and critical care categories. The Eigenfactor metric adjusts the impact factor by eliminating self-citations and factoring in citations in the top-tier journals.
Congratulations to our journal CHEST® !
The journal CHEST® was recently awarded a 2-year impact factor of 7.652, the highest in its history, which equates to a 24% increase over last year’s score. In addition, our 5-year impact factor is 7.854, a 7% increase over last year. With respect to the 2-year factor, CHEST® is ranked 4th out of 33 journals in the Critical Care category and 7th out of 59 journals in the Respiratory System category.
Our recent Eigenfactor places us as the second-highest ranked journal in both respiratory and critical care categories. The Eigenfactor metric adjusts the impact factor by eliminating self-citations and factoring in citations in the top-tier journals.
Congratulations to our journal CHEST® !
CHEST NetWorks
Palliative and End-of-Life Care
Patient-tailored goals-of-care discussions: Is this the new standard?
Goals-of-care discussions can be challenging conversations for even the most seasoned physicians. The challenge often is not just the timing but also knowing how to stitch together the content of the discussion. In most cases, physicians have minimal prior knowledge of patient and family preferences, and this adds to the complexity. In addition, the majority of these discussions happen in the inpatient setting (Mack et al. Ann Intern Med. 2012;156[3]:204) where the acuity of the illness adds to the barriers of effective communication (Fulmer et al. J Am Geriatr Soc. 2018;May 23. doi: 10.1111/jgs.15374. [Epub ahead of print]). Can these discussions be tailored to suit individual patient needs and can such attempts better goals-of-care communication? A recent publication by Curtis et al in JAMA Internal Medicine (2018;178[7]:930) attempts to shed light on these unanswered questions and provide physician guidance to better engage in these critical discussions. The cluster-randomized trial included both clinicians and patients. Patients were sent a survey assessing their individual preferences, and physicians were given a summary and communication tips based on these preferences (Jumpstart-Tips). This simple, cost-effective yet scalable intervention was able to improve the frequency, documentation, and patient-assessed quality of goals-of-care discussions in an outpatient setting. In addition, the delivery of goal-concordant care was increased at 3 months in the subgroup of patients with stable goals. A notable limitation of this study was the low participation among physicians. Further studies will be needed to further dissect the characteristics of participating and nonparticipating physicians. Research will also be needed to ascertain how to seamlessly integrate this into health-care delivery. But one irrefutable point is that interventions to improve communication hold the key to better end-of-life care delivery for our patients with serious illnesses. Drs. Paladino and Bernacki have aptly noted in their commentary (JAMA Intern Med. 2018;178[7]:940): “In the age of precision medicine, one can imagine a future of precision communication, where we….provide customized direction for clinicians to begin these discussions based on patient-specific needs.” One question remains. Will this be the new standard? The answer lies with us, the clinicians. My answer to this is a resounding “Yes,” and I hope early adopters will lead the way and prove me right.
Shine Raju, MD, MBBS
Steering Committee Member
Respiratory Care
Prevention of health-care professional errors in use of inhalers
Asthma affects approximately 300 million people worldwide. The 2018 Global Initiative for Asthma (GINA) guidelines recommend assessing the patient’s inhaler technique on a regular basis (www.ginasthma.org. Updated 2018. Accessed August 1, 2018).
The pressurized metered-dose inhaler (pMDI) and dry powder inhaler (DPI) are the most common aerosolized medication delivery devices.
Proper inhaler technique optimizes delivery of medication, and patients rely on a variety of their health-care providers (HCP) to teach them to use the devices. Unfortunately, evidence demonstrates patients are unable to use their inhalers properly (Sanchis et al. Chest. 2016;150[2]:394). Improper and inadequate inhaler technique is commonly associated with poor disease control, exacerbations, hospitalization stays, and need for systemic corticosteroids and antibiotic therapy (Capanoglu et al. J Asthma. 2015;52[8]:838; Levy et al. Prim Care Respir J. 2013;22:406; Westerik et al. J Asthma. 2015;53[3]:1).
Incorrect inhaler use is attributed to the design of the device, poor patient understanding, and HCPs having insufficient knowledge of the inhalers and performed the correct inhaled technique 15.5% of the time (Plaza et al. J Allergy Clin Immunol Prac. 2018;6[3]:987).
Health-care providers who are directly responsible for managing patients with pulmonary disease must have knowledge of correct inhaler techniques to effectively teach patients and properly assess their use of these devices. The quality of the HCP instruction to the patient is key to reducing poor inhaler technique (Klijn et al. NPJ Prim Care Respir Med. 2017;;27[1]:24. doi: 10.1038/s41533-017-0022-1). Targeted inhaler technique educational programs for HCPs have been shown to improve clinical outcomes of patients with asthma (Myers. Respir Care. 2015;60[8]:1190). The Respiratory Care NetWork is developing HCP and patient handouts for each aerosol delivery device which may be available in early 2019.
De De Gardner, DrPH, RRT-NPS, FCCP
Steering Committee Member
Sleep Medicine
Pediatric Sleep Disorders
The Sleep Medicine Network has worked hard to contribute to the CHEST 2018 exciting program of events by highlighting hot topics, discussing clinical controversies, and presenting challenging cases in sleep medicine. The goal of the Sleep Medicine Network has been to design content relevant to the diverse audience attending CHEST in San Antonio this year.
This goal includes topics relevant to pediatric sleep medicine. Why is this important to the larger audience at CHEST? Demand for pediatric sleep physicians significantly out paces access in many areas of this country (Phillips et al. Am J Respir Crit Care Med. 2015;192[8]:915). Adult sleep physicians may treat older children or adolescents in their practice, they may care for medically complex children when they transition to adulthood, and they may be asked for advice regarding the sleep concerns of children of their friends and colleagues. Sleep problems in children are common and may affect up to a quarter of children at some point during their lifetime (Owens. Prim Care. 2008;35[3]:533). The entire household is affected when children are not receiving adequate sleep; the sleep of their caregivers and family members is impacted. While many similarities exist between adult and pediatric sleep medicine, physicians who regularly care for children need to be aware of the important differences in the evaluation and treatment of pediatric sleep disorders.
How else can we connect with your practice? If you have an important topic you would like considered for CHEST 2019 please seek out the Sleep Medicine Network meeting in San Antonio, so we can continue to generate relevant content for your practice.
Julie Baughn, MD
Steering Committee Member
Palliative and End-of-Life Care
Patient-tailored goals-of-care discussions: Is this the new standard?
Goals-of-care discussions can be challenging conversations for even the most seasoned physicians. The challenge often is not just the timing but also knowing how to stitch together the content of the discussion. In most cases, physicians have minimal prior knowledge of patient and family preferences, and this adds to the complexity. In addition, the majority of these discussions happen in the inpatient setting (Mack et al. Ann Intern Med. 2012;156[3]:204) where the acuity of the illness adds to the barriers of effective communication (Fulmer et al. J Am Geriatr Soc. 2018;May 23. doi: 10.1111/jgs.15374. [Epub ahead of print]). Can these discussions be tailored to suit individual patient needs and can such attempts better goals-of-care communication? A recent publication by Curtis et al in JAMA Internal Medicine (2018;178[7]:930) attempts to shed light on these unanswered questions and provide physician guidance to better engage in these critical discussions. The cluster-randomized trial included both clinicians and patients. Patients were sent a survey assessing their individual preferences, and physicians were given a summary and communication tips based on these preferences (Jumpstart-Tips). This simple, cost-effective yet scalable intervention was able to improve the frequency, documentation, and patient-assessed quality of goals-of-care discussions in an outpatient setting. In addition, the delivery of goal-concordant care was increased at 3 months in the subgroup of patients with stable goals. A notable limitation of this study was the low participation among physicians. Further studies will be needed to further dissect the characteristics of participating and nonparticipating physicians. Research will also be needed to ascertain how to seamlessly integrate this into health-care delivery. But one irrefutable point is that interventions to improve communication hold the key to better end-of-life care delivery for our patients with serious illnesses. Drs. Paladino and Bernacki have aptly noted in their commentary (JAMA Intern Med. 2018;178[7]:940): “In the age of precision medicine, one can imagine a future of precision communication, where we….provide customized direction for clinicians to begin these discussions based on patient-specific needs.” One question remains. Will this be the new standard? The answer lies with us, the clinicians. My answer to this is a resounding “Yes,” and I hope early adopters will lead the way and prove me right.
Shine Raju, MD, MBBS
Steering Committee Member
Respiratory Care
Prevention of health-care professional errors in use of inhalers
Asthma affects approximately 300 million people worldwide. The 2018 Global Initiative for Asthma (GINA) guidelines recommend assessing the patient’s inhaler technique on a regular basis (www.ginasthma.org. Updated 2018. Accessed August 1, 2018).
The pressurized metered-dose inhaler (pMDI) and dry powder inhaler (DPI) are the most common aerosolized medication delivery devices.
Proper inhaler technique optimizes delivery of medication, and patients rely on a variety of their health-care providers (HCP) to teach them to use the devices. Unfortunately, evidence demonstrates patients are unable to use their inhalers properly (Sanchis et al. Chest. 2016;150[2]:394). Improper and inadequate inhaler technique is commonly associated with poor disease control, exacerbations, hospitalization stays, and need for systemic corticosteroids and antibiotic therapy (Capanoglu et al. J Asthma. 2015;52[8]:838; Levy et al. Prim Care Respir J. 2013;22:406; Westerik et al. J Asthma. 2015;53[3]:1).
Incorrect inhaler use is attributed to the design of the device, poor patient understanding, and HCPs having insufficient knowledge of the inhalers and performed the correct inhaled technique 15.5% of the time (Plaza et al. J Allergy Clin Immunol Prac. 2018;6[3]:987).
Health-care providers who are directly responsible for managing patients with pulmonary disease must have knowledge of correct inhaler techniques to effectively teach patients and properly assess their use of these devices. The quality of the HCP instruction to the patient is key to reducing poor inhaler technique (Klijn et al. NPJ Prim Care Respir Med. 2017;;27[1]:24. doi: 10.1038/s41533-017-0022-1). Targeted inhaler technique educational programs for HCPs have been shown to improve clinical outcomes of patients with asthma (Myers. Respir Care. 2015;60[8]:1190). The Respiratory Care NetWork is developing HCP and patient handouts for each aerosol delivery device which may be available in early 2019.
De De Gardner, DrPH, RRT-NPS, FCCP
Steering Committee Member
Sleep Medicine
Pediatric Sleep Disorders
The Sleep Medicine Network has worked hard to contribute to the CHEST 2018 exciting program of events by highlighting hot topics, discussing clinical controversies, and presenting challenging cases in sleep medicine. The goal of the Sleep Medicine Network has been to design content relevant to the diverse audience attending CHEST in San Antonio this year.
This goal includes topics relevant to pediatric sleep medicine. Why is this important to the larger audience at CHEST? Demand for pediatric sleep physicians significantly out paces access in many areas of this country (Phillips et al. Am J Respir Crit Care Med. 2015;192[8]:915). Adult sleep physicians may treat older children or adolescents in their practice, they may care for medically complex children when they transition to adulthood, and they may be asked for advice regarding the sleep concerns of children of their friends and colleagues. Sleep problems in children are common and may affect up to a quarter of children at some point during their lifetime (Owens. Prim Care. 2008;35[3]:533). The entire household is affected when children are not receiving adequate sleep; the sleep of their caregivers and family members is impacted. While many similarities exist between adult and pediatric sleep medicine, physicians who regularly care for children need to be aware of the important differences in the evaluation and treatment of pediatric sleep disorders.
How else can we connect with your practice? If you have an important topic you would like considered for CHEST 2019 please seek out the Sleep Medicine Network meeting in San Antonio, so we can continue to generate relevant content for your practice.
Julie Baughn, MD
Steering Committee Member
Palliative and End-of-Life Care
Patient-tailored goals-of-care discussions: Is this the new standard?
Goals-of-care discussions can be challenging conversations for even the most seasoned physicians. The challenge often is not just the timing but also knowing how to stitch together the content of the discussion. In most cases, physicians have minimal prior knowledge of patient and family preferences, and this adds to the complexity. In addition, the majority of these discussions happen in the inpatient setting (Mack et al. Ann Intern Med. 2012;156[3]:204) where the acuity of the illness adds to the barriers of effective communication (Fulmer et al. J Am Geriatr Soc. 2018;May 23. doi: 10.1111/jgs.15374. [Epub ahead of print]). Can these discussions be tailored to suit individual patient needs and can such attempts better goals-of-care communication? A recent publication by Curtis et al in JAMA Internal Medicine (2018;178[7]:930) attempts to shed light on these unanswered questions and provide physician guidance to better engage in these critical discussions. The cluster-randomized trial included both clinicians and patients. Patients were sent a survey assessing their individual preferences, and physicians were given a summary and communication tips based on these preferences (Jumpstart-Tips). This simple, cost-effective yet scalable intervention was able to improve the frequency, documentation, and patient-assessed quality of goals-of-care discussions in an outpatient setting. In addition, the delivery of goal-concordant care was increased at 3 months in the subgroup of patients with stable goals. A notable limitation of this study was the low participation among physicians. Further studies will be needed to further dissect the characteristics of participating and nonparticipating physicians. Research will also be needed to ascertain how to seamlessly integrate this into health-care delivery. But one irrefutable point is that interventions to improve communication hold the key to better end-of-life care delivery for our patients with serious illnesses. Drs. Paladino and Bernacki have aptly noted in their commentary (JAMA Intern Med. 2018;178[7]:940): “In the age of precision medicine, one can imagine a future of precision communication, where we….provide customized direction for clinicians to begin these discussions based on patient-specific needs.” One question remains. Will this be the new standard? The answer lies with us, the clinicians. My answer to this is a resounding “Yes,” and I hope early adopters will lead the way and prove me right.
Shine Raju, MD, MBBS
Steering Committee Member
Respiratory Care
Prevention of health-care professional errors in use of inhalers
Asthma affects approximately 300 million people worldwide. The 2018 Global Initiative for Asthma (GINA) guidelines recommend assessing the patient’s inhaler technique on a regular basis (www.ginasthma.org. Updated 2018. Accessed August 1, 2018).
The pressurized metered-dose inhaler (pMDI) and dry powder inhaler (DPI) are the most common aerosolized medication delivery devices.
Proper inhaler technique optimizes delivery of medication, and patients rely on a variety of their health-care providers (HCP) to teach them to use the devices. Unfortunately, evidence demonstrates patients are unable to use their inhalers properly (Sanchis et al. Chest. 2016;150[2]:394). Improper and inadequate inhaler technique is commonly associated with poor disease control, exacerbations, hospitalization stays, and need for systemic corticosteroids and antibiotic therapy (Capanoglu et al. J Asthma. 2015;52[8]:838; Levy et al. Prim Care Respir J. 2013;22:406; Westerik et al. J Asthma. 2015;53[3]:1).
Incorrect inhaler use is attributed to the design of the device, poor patient understanding, and HCPs having insufficient knowledge of the inhalers and performed the correct inhaled technique 15.5% of the time (Plaza et al. J Allergy Clin Immunol Prac. 2018;6[3]:987).
Health-care providers who are directly responsible for managing patients with pulmonary disease must have knowledge of correct inhaler techniques to effectively teach patients and properly assess their use of these devices. The quality of the HCP instruction to the patient is key to reducing poor inhaler technique (Klijn et al. NPJ Prim Care Respir Med. 2017;;27[1]:24. doi: 10.1038/s41533-017-0022-1). Targeted inhaler technique educational programs for HCPs have been shown to improve clinical outcomes of patients with asthma (Myers. Respir Care. 2015;60[8]:1190). The Respiratory Care NetWork is developing HCP and patient handouts for each aerosol delivery device which may be available in early 2019.
De De Gardner, DrPH, RRT-NPS, FCCP
Steering Committee Member
Sleep Medicine
Pediatric Sleep Disorders
The Sleep Medicine Network has worked hard to contribute to the CHEST 2018 exciting program of events by highlighting hot topics, discussing clinical controversies, and presenting challenging cases in sleep medicine. The goal of the Sleep Medicine Network has been to design content relevant to the diverse audience attending CHEST in San Antonio this year.
This goal includes topics relevant to pediatric sleep medicine. Why is this important to the larger audience at CHEST? Demand for pediatric sleep physicians significantly out paces access in many areas of this country (Phillips et al. Am J Respir Crit Care Med. 2015;192[8]:915). Adult sleep physicians may treat older children or adolescents in their practice, they may care for medically complex children when they transition to adulthood, and they may be asked for advice regarding the sleep concerns of children of their friends and colleagues. Sleep problems in children are common and may affect up to a quarter of children at some point during their lifetime (Owens. Prim Care. 2008;35[3]:533). The entire household is affected when children are not receiving adequate sleep; the sleep of their caregivers and family members is impacted. While many similarities exist between adult and pediatric sleep medicine, physicians who regularly care for children need to be aware of the important differences in the evaluation and treatment of pediatric sleep disorders.
How else can we connect with your practice? If you have an important topic you would like considered for CHEST 2019 please seek out the Sleep Medicine Network meeting in San Antonio, so we can continue to generate relevant content for your practice.
Julie Baughn, MD
Steering Committee Member
CHEST Keynote: Reflections of a Lifetime Practicing Chest Medicine
Dr. Richard Irwin, the Editor in Chief for the journal CHEST, and Chair of UMass Memorial Medical Center’s Department of Critical Care, has observed the way patient-focused care has evolved through the years. He will be speaking on this topic at the CHEST 2018 opening session on Sunday, October 7.
During Dr. Irwin’s early years at UMass Memorial, the then chairman of Medicine, Dr. James Dalen, a longtime CHEST member who was about to begin his term as CHEST President, strongly encouraged Dr. Irwin to join the organization. By joining the college, Dr. Irwin was able to form strong connections with other influential chest medicine professionals, such as Dr. Jack Weg, a former CHEST President, and Dr. Alfred Soffer – who was the Editor in Chief of CHEST.
While Dr. Irwin was not yet a member of the CHEST community, the college became instrumental in focusing Dr. Irwin’s academic career because of a manuscript that he and colleagues had been working on, titled Cough. A Comprehensive Review. After submitting the early version of his manuscript to ten different journals and being rejected by each one, Dr. Irwin contacted Dr. Soffer and asked him, if he had the time, could he please read it and offer advice. Dr. Soffer, who had a reputation of being a mentor with endless generosity of his time, reviewed the manuscript and worked with Dr. Irwin on the article, leading to its publication in the Archives of Internal Medicine in 1977. Dr. Soffer’s kindness would lead to the start of Dr. Irwin’s 40-year career of studying cough.
Dr. Irwin has been very influential within the CHEST organization throughout his career. In addition to his years as the Editor in Chief of CHEST, he also served on every major CHEST committee and held the office of CHEST President in 2003-2004. “If you want to join a society that has a family-feel to it and focuses on clinical care and education, then CHEST is the place to be.”
Throughout his years as a physician, Dr. Irwin has been interested in the way physicians learn. During his formative years, he says the way he learned was to “see one, do one, teach one.” He gives the example of the flexible fiber-optic bronchoscope, which was developed in Japan in the late 1960s, arriving in the US in 1970. It was a new way of performing bronchoscopy, which led to physicians reading about it, and then putting what they read into action. Now – there are high fidelity simulation instruments and models and a lot of experiential learning prefacing the use of new technologies for patients. We have CHEST to thank for being a leader in experiential learning and an international resource for simulation training.
Dr. Richard Irwin, the Editor in Chief for the journal CHEST, and Chair of UMass Memorial Medical Center’s Department of Critical Care, has observed the way patient-focused care has evolved through the years. He will be speaking on this topic at the CHEST 2018 opening session on Sunday, October 7.
During Dr. Irwin’s early years at UMass Memorial, the then chairman of Medicine, Dr. James Dalen, a longtime CHEST member who was about to begin his term as CHEST President, strongly encouraged Dr. Irwin to join the organization. By joining the college, Dr. Irwin was able to form strong connections with other influential chest medicine professionals, such as Dr. Jack Weg, a former CHEST President, and Dr. Alfred Soffer – who was the Editor in Chief of CHEST.
While Dr. Irwin was not yet a member of the CHEST community, the college became instrumental in focusing Dr. Irwin’s academic career because of a manuscript that he and colleagues had been working on, titled Cough. A Comprehensive Review. After submitting the early version of his manuscript to ten different journals and being rejected by each one, Dr. Irwin contacted Dr. Soffer and asked him, if he had the time, could he please read it and offer advice. Dr. Soffer, who had a reputation of being a mentor with endless generosity of his time, reviewed the manuscript and worked with Dr. Irwin on the article, leading to its publication in the Archives of Internal Medicine in 1977. Dr. Soffer’s kindness would lead to the start of Dr. Irwin’s 40-year career of studying cough.
Dr. Irwin has been very influential within the CHEST organization throughout his career. In addition to his years as the Editor in Chief of CHEST, he also served on every major CHEST committee and held the office of CHEST President in 2003-2004. “If you want to join a society that has a family-feel to it and focuses on clinical care and education, then CHEST is the place to be.”
Throughout his years as a physician, Dr. Irwin has been interested in the way physicians learn. During his formative years, he says the way he learned was to “see one, do one, teach one.” He gives the example of the flexible fiber-optic bronchoscope, which was developed in Japan in the late 1960s, arriving in the US in 1970. It was a new way of performing bronchoscopy, which led to physicians reading about it, and then putting what they read into action. Now – there are high fidelity simulation instruments and models and a lot of experiential learning prefacing the use of new technologies for patients. We have CHEST to thank for being a leader in experiential learning and an international resource for simulation training.
Dr. Richard Irwin, the Editor in Chief for the journal CHEST, and Chair of UMass Memorial Medical Center’s Department of Critical Care, has observed the way patient-focused care has evolved through the years. He will be speaking on this topic at the CHEST 2018 opening session on Sunday, October 7.
During Dr. Irwin’s early years at UMass Memorial, the then chairman of Medicine, Dr. James Dalen, a longtime CHEST member who was about to begin his term as CHEST President, strongly encouraged Dr. Irwin to join the organization. By joining the college, Dr. Irwin was able to form strong connections with other influential chest medicine professionals, such as Dr. Jack Weg, a former CHEST President, and Dr. Alfred Soffer – who was the Editor in Chief of CHEST.
While Dr. Irwin was not yet a member of the CHEST community, the college became instrumental in focusing Dr. Irwin’s academic career because of a manuscript that he and colleagues had been working on, titled Cough. A Comprehensive Review. After submitting the early version of his manuscript to ten different journals and being rejected by each one, Dr. Irwin contacted Dr. Soffer and asked him, if he had the time, could he please read it and offer advice. Dr. Soffer, who had a reputation of being a mentor with endless generosity of his time, reviewed the manuscript and worked with Dr. Irwin on the article, leading to its publication in the Archives of Internal Medicine in 1977. Dr. Soffer’s kindness would lead to the start of Dr. Irwin’s 40-year career of studying cough.
Dr. Irwin has been very influential within the CHEST organization throughout his career. In addition to his years as the Editor in Chief of CHEST, he also served on every major CHEST committee and held the office of CHEST President in 2003-2004. “If you want to join a society that has a family-feel to it and focuses on clinical care and education, then CHEST is the place to be.”
Throughout his years as a physician, Dr. Irwin has been interested in the way physicians learn. During his formative years, he says the way he learned was to “see one, do one, teach one.” He gives the example of the flexible fiber-optic bronchoscope, which was developed in Japan in the late 1960s, arriving in the US in 1970. It was a new way of performing bronchoscopy, which led to physicians reading about it, and then putting what they read into action. Now – there are high fidelity simulation instruments and models and a lot of experiential learning prefacing the use of new technologies for patients. We have CHEST to thank for being a leader in experiential learning and an international resource for simulation training.
NetWorks Challenge recap
The CHEST Foundation is proud to announce the completion of the 2018 NetWorks Challenge Giving Month! Through your generous contributions, we reached our ambitious fundraising goal of $60,000 over the course of just 1 month.
This year, every NetWork was eligible to win travel grants to CHEST 2018 by donating in their NetWorks name during the month of June.
The highest contributing NetWork, Pulmonary and Vascular Disease NetWork, and the NetWork with highest percentage of participation, the Practice Operations NetWork, each receive additional travel grants and session time at CHEST 2018! Additionally, the Transplant NetWork raised over $5,000 through their efforts and will be receiving a travel grant to CHEST 2018 for their strong support of our clinical research grants, patient education initiatives, and community service events.
Thank you to all who contributed during the NetWorks Challenge Giving Month!
The CHEST Foundation is proud to announce the completion of the 2018 NetWorks Challenge Giving Month! Through your generous contributions, we reached our ambitious fundraising goal of $60,000 over the course of just 1 month.
This year, every NetWork was eligible to win travel grants to CHEST 2018 by donating in their NetWorks name during the month of June.
The highest contributing NetWork, Pulmonary and Vascular Disease NetWork, and the NetWork with highest percentage of participation, the Practice Operations NetWork, each receive additional travel grants and session time at CHEST 2018! Additionally, the Transplant NetWork raised over $5,000 through their efforts and will be receiving a travel grant to CHEST 2018 for their strong support of our clinical research grants, patient education initiatives, and community service events.
Thank you to all who contributed during the NetWorks Challenge Giving Month!
The CHEST Foundation is proud to announce the completion of the 2018 NetWorks Challenge Giving Month! Through your generous contributions, we reached our ambitious fundraising goal of $60,000 over the course of just 1 month.
This year, every NetWork was eligible to win travel grants to CHEST 2018 by donating in their NetWorks name during the month of June.
The highest contributing NetWork, Pulmonary and Vascular Disease NetWork, and the NetWork with highest percentage of participation, the Practice Operations NetWork, each receive additional travel grants and session time at CHEST 2018! Additionally, the Transplant NetWork raised over $5,000 through their efforts and will be receiving a travel grant to CHEST 2018 for their strong support of our clinical research grants, patient education initiatives, and community service events.
Thank you to all who contributed during the NetWorks Challenge Giving Month!
NAMDRC News
NAMDRC will host its 42nd Annual Educational Conference March 14-16, 2019, in Sonoma, California, with a blue chip program featuring nationally recognized speakers. Keynote speakers include Bartolome Celli, MD, FCCP; E. Wesley Ely Jr., MD, FCCP; and a special “Conversation on Health Care Strategies” with Troyen Brennan, MD, Executive Vice President and Chief Medical Officer of CVS Health.
The NAMDRC conference format is unlike other pulmonary focused conferences. All sessions are plenary, and speakers are encouraged to take advantage of our wireless audience response system by simply texting their responses to questions. Sessions begin by 8:00 AM each day and conclude by 12:30 PM to provide ample time for all attendees to enjoy the Napa Sonoma region.
Details regarding registration, lodging, and more specifics regarding the program, social events, and related matters are available at the NAMDRC website at www.namdrc.org.
A few highlights:
• Thursday, March 14
Wesley Ely, MD – ICU Liberation and the ABCDEF Bundle – New Data; and ICU Delirium in Ventilated Patients – New Data
Neil MacIntyre, MD – Managing Severe Hypoxemic Respiratory Failure: The Ever Expanding Evidence Base
Samuel Hammerman, MD – Role of Long Term Acute Care
A Panel with Drs. Ely and MacIntyre – Challenges in Critical Care: Spontaneous Ventilation in Lung Injury, ECMO and Other.
Troyen Brennan, MD – A Conversation on Health Care Strategies
• Friday, March 15
Peter Gay, MD, FCCP – Heart Failure in Central Sleep Apnea
Susan Jacobs, RN, Christine Garvey, FNP, MSN, Phil Porte – Optimizing Oxygen Therapy
Bartolome Celli, MD, FCCP – Changing the Natural Course of COPD
Alan Plummer, MD, FCCP – Coding Update, 2019
Steve Peters, MD, FCCP – Practice Management Update
Phillip Porte – Legislative and Regulatory Updates
• Saturday, March 16
Bartolome Celli, MD, FCCP -- Pharmacological Therapy of COPD: Reasons for Optimism
Richard Channick, MD – Management of Acute Pulmonary Embolism: New Approaches
Colleen Channick, MD – The Role of Interventional Pulmonology in the Management of Cancer: From Diagnosis to Palliation
Stanley Yung-Chuan Lui, MD – Surgical Approach to OSA
Daniel Culver, DO, FCCP – Sarcoidosis
Regulatory proposals from CMS trigger NAMDRC responses
CMS has released several proposed rules to take effect January 1 that, if implemented as proposed, will impact patients, as well as physicians. The first regulation recommends important changes in the durable medical equipment competitive bidding program in general, with specific recommendations related to improving availability of liquid oxygen. CMS acknowledges that access to liquid oxygen has become problematic and is seeking comment on a proposal that would bump payment for liquid oxygen, including high flow, approximately 50%.
While the acknowledgement is important, the proposed solution falls far short of what virtually everyone in the industry believes is workable. For perspective, allowable charges for 2016 for liquid portable systems was just over $2 million, less than 2% of all outlays for portable equipment. Statutory language would require “budget neutrality,” thereby reducing payment for all other oxygen systems to bump liquid payment. Experts in the field agree that the proposed 50% bump is nowhere near the bump necessary to address the costs to suppliers to provide oxygen. Just as most oxygen modalities fit into the “nondelivery business model” that has reduced direct contact with patients, liquid fits into a “delivery business model” that necessitates constant refills by the supplier. That added cost needs to be reflected in any payment, and competitive bidding has eviscerated that payment.
NAMDRC and other societies recommend a “carve out” for liquid oxygen, removing it entirely from competitive bidding. While this approach would revert to a 1986 payment methodology, adjusted over time, it could be enough incentive for some suppliers to re-enter the liquid arena.
The second proposal espoused by CMS reduces payment for Level 4 and Level 5 office visits, with extra dollars going to lower intensity visits. Depending on a physician’s particular practice, the impact could be minimal or, at the other end of the spectrum, quite damaging. The proposal has its origins with the family practice community, long frustrated by the relatively low payment for Level 1 and level 2 visits. CMS ostensibly refers to reduced paperwork, but most physician groups see the real impact affecting their memberships.
CMS will publish final rules, reflecting public comment, around November 1, with an implementation date of January 1, 2019.
NAMDRC will host its 42nd Annual Educational Conference March 14-16, 2019, in Sonoma, California, with a blue chip program featuring nationally recognized speakers. Keynote speakers include Bartolome Celli, MD, FCCP; E. Wesley Ely Jr., MD, FCCP; and a special “Conversation on Health Care Strategies” with Troyen Brennan, MD, Executive Vice President and Chief Medical Officer of CVS Health.
The NAMDRC conference format is unlike other pulmonary focused conferences. All sessions are plenary, and speakers are encouraged to take advantage of our wireless audience response system by simply texting their responses to questions. Sessions begin by 8:00 AM each day and conclude by 12:30 PM to provide ample time for all attendees to enjoy the Napa Sonoma region.
Details regarding registration, lodging, and more specifics regarding the program, social events, and related matters are available at the NAMDRC website at www.namdrc.org.
A few highlights:
• Thursday, March 14
Wesley Ely, MD – ICU Liberation and the ABCDEF Bundle – New Data; and ICU Delirium in Ventilated Patients – New Data
Neil MacIntyre, MD – Managing Severe Hypoxemic Respiratory Failure: The Ever Expanding Evidence Base
Samuel Hammerman, MD – Role of Long Term Acute Care
A Panel with Drs. Ely and MacIntyre – Challenges in Critical Care: Spontaneous Ventilation in Lung Injury, ECMO and Other.
Troyen Brennan, MD – A Conversation on Health Care Strategies
• Friday, March 15
Peter Gay, MD, FCCP – Heart Failure in Central Sleep Apnea
Susan Jacobs, RN, Christine Garvey, FNP, MSN, Phil Porte – Optimizing Oxygen Therapy
Bartolome Celli, MD, FCCP – Changing the Natural Course of COPD
Alan Plummer, MD, FCCP – Coding Update, 2019
Steve Peters, MD, FCCP – Practice Management Update
Phillip Porte – Legislative and Regulatory Updates
• Saturday, March 16
Bartolome Celli, MD, FCCP -- Pharmacological Therapy of COPD: Reasons for Optimism
Richard Channick, MD – Management of Acute Pulmonary Embolism: New Approaches
Colleen Channick, MD – The Role of Interventional Pulmonology in the Management of Cancer: From Diagnosis to Palliation
Stanley Yung-Chuan Lui, MD – Surgical Approach to OSA
Daniel Culver, DO, FCCP – Sarcoidosis
Regulatory proposals from CMS trigger NAMDRC responses
CMS has released several proposed rules to take effect January 1 that, if implemented as proposed, will impact patients, as well as physicians. The first regulation recommends important changes in the durable medical equipment competitive bidding program in general, with specific recommendations related to improving availability of liquid oxygen. CMS acknowledges that access to liquid oxygen has become problematic and is seeking comment on a proposal that would bump payment for liquid oxygen, including high flow, approximately 50%.
While the acknowledgement is important, the proposed solution falls far short of what virtually everyone in the industry believes is workable. For perspective, allowable charges for 2016 for liquid portable systems was just over $2 million, less than 2% of all outlays for portable equipment. Statutory language would require “budget neutrality,” thereby reducing payment for all other oxygen systems to bump liquid payment. Experts in the field agree that the proposed 50% bump is nowhere near the bump necessary to address the costs to suppliers to provide oxygen. Just as most oxygen modalities fit into the “nondelivery business model” that has reduced direct contact with patients, liquid fits into a “delivery business model” that necessitates constant refills by the supplier. That added cost needs to be reflected in any payment, and competitive bidding has eviscerated that payment.
NAMDRC and other societies recommend a “carve out” for liquid oxygen, removing it entirely from competitive bidding. While this approach would revert to a 1986 payment methodology, adjusted over time, it could be enough incentive for some suppliers to re-enter the liquid arena.
The second proposal espoused by CMS reduces payment for Level 4 and Level 5 office visits, with extra dollars going to lower intensity visits. Depending on a physician’s particular practice, the impact could be minimal or, at the other end of the spectrum, quite damaging. The proposal has its origins with the family practice community, long frustrated by the relatively low payment for Level 1 and level 2 visits. CMS ostensibly refers to reduced paperwork, but most physician groups see the real impact affecting their memberships.
CMS will publish final rules, reflecting public comment, around November 1, with an implementation date of January 1, 2019.
NAMDRC will host its 42nd Annual Educational Conference March 14-16, 2019, in Sonoma, California, with a blue chip program featuring nationally recognized speakers. Keynote speakers include Bartolome Celli, MD, FCCP; E. Wesley Ely Jr., MD, FCCP; and a special “Conversation on Health Care Strategies” with Troyen Brennan, MD, Executive Vice President and Chief Medical Officer of CVS Health.
The NAMDRC conference format is unlike other pulmonary focused conferences. All sessions are plenary, and speakers are encouraged to take advantage of our wireless audience response system by simply texting their responses to questions. Sessions begin by 8:00 AM each day and conclude by 12:30 PM to provide ample time for all attendees to enjoy the Napa Sonoma region.
Details regarding registration, lodging, and more specifics regarding the program, social events, and related matters are available at the NAMDRC website at www.namdrc.org.
A few highlights:
• Thursday, March 14
Wesley Ely, MD – ICU Liberation and the ABCDEF Bundle – New Data; and ICU Delirium in Ventilated Patients – New Data
Neil MacIntyre, MD – Managing Severe Hypoxemic Respiratory Failure: The Ever Expanding Evidence Base
Samuel Hammerman, MD – Role of Long Term Acute Care
A Panel with Drs. Ely and MacIntyre – Challenges in Critical Care: Spontaneous Ventilation in Lung Injury, ECMO and Other.
Troyen Brennan, MD – A Conversation on Health Care Strategies
• Friday, March 15
Peter Gay, MD, FCCP – Heart Failure in Central Sleep Apnea
Susan Jacobs, RN, Christine Garvey, FNP, MSN, Phil Porte – Optimizing Oxygen Therapy
Bartolome Celli, MD, FCCP – Changing the Natural Course of COPD
Alan Plummer, MD, FCCP – Coding Update, 2019
Steve Peters, MD, FCCP – Practice Management Update
Phillip Porte – Legislative and Regulatory Updates
• Saturday, March 16
Bartolome Celli, MD, FCCP -- Pharmacological Therapy of COPD: Reasons for Optimism
Richard Channick, MD – Management of Acute Pulmonary Embolism: New Approaches
Colleen Channick, MD – The Role of Interventional Pulmonology in the Management of Cancer: From Diagnosis to Palliation
Stanley Yung-Chuan Lui, MD – Surgical Approach to OSA
Daniel Culver, DO, FCCP – Sarcoidosis
Regulatory proposals from CMS trigger NAMDRC responses
CMS has released several proposed rules to take effect January 1 that, if implemented as proposed, will impact patients, as well as physicians. The first regulation recommends important changes in the durable medical equipment competitive bidding program in general, with specific recommendations related to improving availability of liquid oxygen. CMS acknowledges that access to liquid oxygen has become problematic and is seeking comment on a proposal that would bump payment for liquid oxygen, including high flow, approximately 50%.
While the acknowledgement is important, the proposed solution falls far short of what virtually everyone in the industry believes is workable. For perspective, allowable charges for 2016 for liquid portable systems was just over $2 million, less than 2% of all outlays for portable equipment. Statutory language would require “budget neutrality,” thereby reducing payment for all other oxygen systems to bump liquid payment. Experts in the field agree that the proposed 50% bump is nowhere near the bump necessary to address the costs to suppliers to provide oxygen. Just as most oxygen modalities fit into the “nondelivery business model” that has reduced direct contact with patients, liquid fits into a “delivery business model” that necessitates constant refills by the supplier. That added cost needs to be reflected in any payment, and competitive bidding has eviscerated that payment.
NAMDRC and other societies recommend a “carve out” for liquid oxygen, removing it entirely from competitive bidding. While this approach would revert to a 1986 payment methodology, adjusted over time, it could be enough incentive for some suppliers to re-enter the liquid arena.
The second proposal espoused by CMS reduces payment for Level 4 and Level 5 office visits, with extra dollars going to lower intensity visits. Depending on a physician’s particular practice, the impact could be minimal or, at the other end of the spectrum, quite damaging. The proposal has its origins with the family practice community, long frustrated by the relatively low payment for Level 1 and level 2 visits. CMS ostensibly refers to reduced paperwork, but most physician groups see the real impact affecting their memberships.
CMS will publish final rules, reflecting public comment, around November 1, with an implementation date of January 1, 2019.
Plan to ‘Learn by Doing’ at the CHEST Annual Meeting 2018
Don’t miss the CHEST Annual Meeting 2018 in San Antonio, Oct 6-10. Watch as CHEST 2018 Program Chair David A. Schulman, MD, MPH, FCCP, walks you through the vision of this year’s meeting. View complete details at chestmeeting.chestnet.org.
Don’t miss the CHEST Annual Meeting 2018 in San Antonio, Oct 6-10. Watch as CHEST 2018 Program Chair David A. Schulman, MD, MPH, FCCP, walks you through the vision of this year’s meeting. View complete details at chestmeeting.chestnet.org.
Don’t miss the CHEST Annual Meeting 2018 in San Antonio, Oct 6-10. Watch as CHEST 2018 Program Chair David A. Schulman, MD, MPH, FCCP, walks you through the vision of this year’s meeting. View complete details at chestmeeting.chestnet.org.
